More options than ever are available to treat excessive menstrual bleeding. For
many women, the pain and inconvenience of heavy menstrual bleeding may
interfere with living life to the fullest. If you're among them, the good news
is there are treatment options. Where to start? You can begin by asking
yourself a few simple questions.

Excessive Menstrual Bleeding:
When your period puts your life on hold because menstrual bleeding lasts to
long or is too heavy it's time to ask your doctor a few important questions.
Learn who's mostly to experience heavy menstural bleeding or menorrhagia,
causes of excessive menstrual bleeding, diagnostic tests, and treatments for
menorrhagia and get a list of questions to ask your health care provider about
your heavy periods.

More options than ever are available to treat excessive menstrual bleeding. For
many women, the pain and inconvenience of heavy menstrual bleeding may
interfere with living life to the fullest. If you're among them, the good news
is there are treatment options. Where to start? You can begin by asking
yourself a few simple questions.

Menstruation is the shedding of the lining of the uterus (endometrium), and is a
cycle that repeats itself approximately every 28 days in a woman who is not
pregnant. Excessive menstrual bleeding, also known as menorrhagia, is defined
as blood loss of more than 80mL during a menstrual cycle. This translates into
bleeding for more than 7 days or using more than 10 pads or tampons per day
during the menstrual cycle. Excessive menstrual bleeding is a common cause of
iron-deficiency anemia.

What are the Symptoms?

Women describe the symptoms of excessive menstrual bleeding as unmanageable
bleeding and a constant need to change soaked pads or tampons. They often
complain of fatigue (a common side effect of anemia) and are concerned about
embarrassing accidents.

Do I have excessive menstrual bleeding?

If you suffer from excessive menstrual bleeding, you're not alone. About 1 in 5
women have unusually heavy bleeding. You may be among them if you:

Have periods that typically last seven days or more

Have unmanageable bleeding or clotting

Frequently need to change pads or tampons

Bleed so heavily that you sometimes don't want to leave home

If you've experienced any of these symptoms, you may have a condition known as
excessive menstrual bleeding, medically called menorrhagia, a treatable
condition that affects many women. There are options.

If you've experienced any of these symptoms, you may have a condition known as
excessive menstrual bleeding, medically called menorrhagia, a treatable
condition that affects many women. There are options.

What is Dysfunctional Uterine Bleeding (DUB)?

DUB is a common condition that affects approximately 1 out of 5 (22%) healthy,
menstruating women. More than 10 million American women have this condition. It
occurs because of a hormonal imbalance, and is distinct from other types of
excessive menstrual bleeding because it is unrelated to fibroids, infection or
disease. DUB commonly occurs in adolescents during the years following the
onset of menstruation and results from a hormonal imbalance. It also occurs in
women who are approaching menopause. DUB accounts for 20 percent of the 600,000
hysterectomies performed annually in the U.S.

Causes of Heavy Menstrual Bleeding

A hormonal imbalance during adolescence or menopause is the most common cause
of heavy menstrual bleeding. Sponsored Links During adolescence after girls
have their first periods, and for several years before the onset of menopause
when menstruation ceases, our hormones levels are fluctuating which often leads
to excessive uterine bleeding during our periods. It’s often possible to treat
menorrhagia caused by hormonal imbalances with birth control pills or other
hormones.

Uterine fibroid tumors are another very common cause of excessive menstruation.
It’s important to understand that fibroid tumors are usually benign
(non-cancerous) tumors that often occur in the uterus of women during their
thirties or forties. While the cause of uterine fibroid tumors is unclear, it
is clear that they are estrogen-dependent. Several surgical treatments are
available for treating fibroid tumors of the uterus including myomectomy,
endometrial ablation, uterine artery embalization, and uterine balloon therapy,
as well as hysterectomy. Non-surgical pharmacological treatments for fibroid
tumors include GnRH agonists, oral contraceptives, androgens, RU486 (the
abortion pill), and gestrinone. Some women find natural progesterone to be an
effective treatment for uterine fibroid tumors. Often, when symptoms are not
severe or troublesome, a “wait and see” approach is taken. Once menopause
occurs, uterine fibroid tumors typically shrink and disappear without
treatment.

Cervical polyps are small, fragile growths that begin in either the mucosal
surface of the cervix, or the endocervical canal and protrude through the
opening of the cervix. The cause of cervical polyps is not clear; however, they
are often the result of an infection and many times associated with an abnormal
response to increased estrogen levels or congestion of the blood vessels
located in the cervix. Women most commonly affected by cervical polyps are
those over the age of twenty who have had children. A simple out patient office
procedure that removes the growth, along with antibiotics, is the usual
treatment for cervical polyps.

Endometrial polyps are typically non-cancerous, growths that protrude from the
lining of the uterus. The cause of endometrial polyps is unclear, although they
are often associated with an excess of estrogen following hormone treatment or
some types of ovarian tumors. Treatments for endometrial polyps include
hysteroscopy and D&C.

Lupus is a chronic inflammatory, and autoimmune disease that affects several
parts of the body, particularly the skin, joints, blood, and kidneys. The cause
of lupus is unclear; however, it’s believed that patients have a genetic
predisposition to Lupus and scientists know that environmental factors such as
infections, certain types of antibiotics -- particularly sulpha and penicillin
drugs, UV light, severe stress, hormones and certain other drugs play a key
role in triggering disease symptoms. The symptoms of Lupus vary widely among
patients, as do the treatments which range from avoiding stress to drugs such
as non-steroidal anti-inflammatory medications or NSAIDS, acetaminophen,
steroids, antimalarials, cytoxic or immunosuppressive drugs, and anticoagulants

Pelvic inflammatory disease (PID) is an infection of one or more organs that
affects the uterus, fallopian tubes, and cervix. Sponsored Links PID is, most
often, a sexually transmitted disease; however, it sometimes occurs following
childbirth, abortion, or other gynecological procedures. The recommended
treatment for pelvic inflammatory disease is antibiotic therapy

Cervical cancer is a type of cancer that occurs when cells in the cervix become
abnormal, multiply out of control, and damage healthy parts of the body. The
human papillomavirus, or HPV, is the cause of over ninety percent of all
cervical cancers. Treatments for cervical cancer include surgery, chemotherapy,
and radiation
therapy.

Endometrial cancer occurs when abnormal cells in the uterus or the endometrium
(the lining of the uterus) multiply out of control and damage to the uterus and
other organs. While the cause of endometrial cancer is unknown, it is known
that women diagnosed with this type of cancer tend are usually over fifty,
often have endometrial hyperplasia, or many times use hormone replacement
therapy (HRT). The first treatment for endometrial cancer is usually a
hysterectomy, possibly followed by chemotherapy and/or radiation treatments.

IUDs or intrauterine devices used for contraception are a potential cause of
heavy menstrual bleeding or menorrhagia. Women who experience prolonged or
heavy periods while using the IUD should have the device removed and choose an
alternate method of birth control.

Bleeding disorders occur when it is hard for a person to stop bleeding. While
there are several types of bleeding disorders, the most common type in women is
von Willebrand Disease or VWD. Treatments for von Willebrand Disease involve
the release of stored clotting factors in the blood, or in extreme cases the
replacement of the clotting factor with IV treatment or with prescribed nasal
spray.

Questions to Ask Your Doctor

Excessive menstrual bleeding is an important health issue for women. At least
one in five women bleed so heavily during their periods they have to put their
normal lives on hold. The medical term for this condition is "menorrhagia,"
meaning periods that are too heavy or that go on longer than the typical
seven-day menstrual cycle. It is more common in women over 35 as hormonal
levels shift during the perimenopausal phase. However, heavy menstrual bleeding
can occur at any age. Heavy menstrual bleeding is more than an inconvenience.
It is also the most common cause of iron-related deficiency in women, and, if
it's heavy enough, can even require hospitalization and blood transfusions.

If you experience heavy bleeding during your periods, your health care
professional will conduct tests to rule out underlying problems like fibroids,
uterine cancer, an infection, or endometriosis.

If you don't have any of these conditions, your bleeding is likely caused by
hormonal imbalances. There are several treatments available for heavy menstrual
bleeding, ranging from over-the-counter nonsteroidal anti-inflammatory
medications, oral contraceptives and minimally invasive surgery that preserve
the uterus, to hysterectomy, that removes the uterus.

Talk with your health care professional about heavy menstrual bleeding. Here is
a list of questions to ask at your next office visit.

Do you consider the amount of menstrual bleeding I'm experiencing abnormal?

What tests do you need to conduct to diagnose symptoms, and why are you doing
them?

Is this heavy bleeding affecting my iron level? What can you do about that?

Why are you recommending this particular treatment option for my heavy
bleeding? If that doesn't work, what do you recommend next?

What are the disadvantages and risks associated with each
recommended treatment?

Even if you find a problem like fibroids or endometriosis causing my abnormal
uterine bleeding, is it possible to avoid a hysterectomy?

Am I a candidate for endometrial ablation? What is the success rate for the
technique you use? What kind of complications have you encountered?

The Diagnosis of Heavy Menstrual Bleeding:

It is often very difficult to diagnose true menorrhagia. For one, it is very
difficult to measure blood loss during menstruation, and the perceptions of
women as well as their physicians vary widely.

Some women may overestimate their menstrual flow. In one study 29% of women
reporting menorrhagia had normal menstrual blood flow (less than about 2 oz, or
60 mL). In the study, such women tended to be anxious, unemployed, and also to
have abdominal pain.

Some women underestimate it. For example, women with a family history of
bleeding disorders might have menorrhagia but think it is normal because it is
the same as their mother's or sister's.

Physicians may underestimate their patient's flow. In one study, comparing the
perception of menstrual flow between physicians and patients, physicians
believed that only 3.2% of their patients had menorrhagia while 53.7% of these
patients self-reported the condition using an objective pictorial
self-assessment chart.

Blood Tests

Tests for bleeding disorders are important, particularly in very young women,
before proceeding with invasive tests. Certainly blood testing for anemia is an
important consideration in determining the need and type of treatment.

Imaging Techniques

Ultrasound and Sonohysterography. Ultrasound is the standard imaging technique
for evaluating the uterus and ovaries, detecting fibroids, ovarian cysts and
tumors, and also obstructions in the urinary tract. It uses sound waves to
produce an image of the organs and entails no risk and very little discomfort.
Transvaginal sonohysterography uses ultrasound along with saline infused into
the uterus, which enhances the visualization of the uterus. This technique is
proving to be more accurate than standard ultrasound in identifying potential
problems. Some experts believe it should become a first line diagnostic tool
for diagnosing heavy bleeding. Magnetic Resonance Imaging. Magnetic resonance
imaging (MRI) gives a better image of any fibroids that might be causing
bleeding, but it is expensive and not usually necessary.

Hysteroscopy

Hysteroscopy is a procedure that may be used to detect the presence of fibroids,
polyps, or other causes of bleeding. (It may miss cases of uterine cancer,
however, and is not a substitute for more invasive procedures, such as D&C
or endometrial biopsy, if cancer is suspected.) It is done in the office
setting and requires no incisions. The procedure uses a long flexible or rigid
tube called a hysteroscope, which is inserted into the vagina and through the
cervix to reach the uterus. A fiber optic light source and a tiny camera in the
tube allow the physician to view the cavity. The uterus is filled with saline
or carbon dioxide to inflate the cavity and provide better viewing. This
generally causes cramping. Hysteroscopy is non-invasive, but 30% of women
report severe pain with the procedure. The use of an anesthetic spray such as
lidocaine may be highly effective in preventing pain from this procedure. Other
complications include excessive fluid absorption, infection, and uterine
perforation. Hysteroscopy is also employed as part of surgical procedures. [See
Operative Hysteroscopy.]

Pelvic Examination

A physician will perform a pelvic examination to check for pregnancy-related
conditions and for signs of fibroids or other abnormalities, such as ovarian
cysts.

Medical and Personal History

The physician needs to have a complete history of any medical or personal
conditions that might be causing heavy bleeding. He or she may need the
following information:

Any family history of menstrual problems or bleeding disorders (which should be
suspected in teenage girls with heavy bleeding). It should be noted that, in
some cases, young women with heavy bleeding from inherited conditions may not
even report it if they grew up in a family where such bleeding was considered
normal.

The presence or history of any medical conditions that might be causing heavy
bleeding.Women who visit their gynecologist with menstrual complaints,
particularly heavy bleeding, pelvic pain, or both may actually have an
underlying medical disorder, which must be ruled out.

The pattern of the menstrual bleeding. (If it occurs during regular
menstruation, nonhormonal treatments are tried first.If it is irregular, occurs
between periods, occurs after sex, is associated with pelvic pain, or if it
occurs with premenstrual pain, the physician should look for specific
conditions that may cause these problems.)

Regular use of any medications (including vitamins and over-the-counter
agents).

Diet history, including caffeine and alcohol intake.

Past or present contraceptive use.

Any recent stressful events.

Sexual history. (It is very important that the patient trust the physician
enough to describe any sexual activity that might be risky.)

Keeping a Menstrual Diary. The patient can provide much of this information by
keeping a diary of the amount of bleeding and pain that occurs over the course
of two or three menstrual cycles is very helpful. One method is to track
menstrual flow day by day by observing the pad or tampon. It uses a score of 1
to 20 to signify very light staining to extremely heavy staining. The diary
would also use a scale for pain of 0 to 4 (no pain to severe pain).